Viswanathan Vijay
M.V. Hospital for Diabetes and Diabetes Research Centre, Royapuram, Chennai, India.
Int J Low Extrem Wounds. 2007 Mar;6(1):34-6. doi: 10.1177/1534734606297987.
Foot ulcers are a significant complication of diabetes mellitus and often precede lower extremity amputation. The most frequent underlying etiologies are neuropathy, trauma, deformity, high plantar pressures, and peripheral arterial disease. Loss of protective sensation is the primary factor in foot ulceration in diabetics. Mechanical stresses resulting from joint deformity, limited joint mobility, and poor foot care/footwear are important in the causal pathway of both neuropathic and ischemic ulcers. It was shown that the recurrence of foot infection was common among Indian diabetic patients (52%). A lesser prevalence of peripheral vascular disease (13%) among Indians was noted when compared with those in Western countries (48%). Smoking increases the risk by reducing blood circulation in the legs and reducing sensation in the feet. Prompt and aggressive treatment of diabetic foot ulcers can often prevent exacerbation of the problem and eliminate the potential for amputation. The aim of the therapy should be early intervention to allow prompt healing of the lesion and prevent recurrence once it is healed. Multidisciplinary management programs that focus on prevention, education, regular foot examinations, aggressive intervention, and optimal use of therapeutic footwear have demonstrated significant reductions in the history of lower extremity amputations.
足部溃疡是糖尿病的一种严重并发症，常先于下肢截肢出现。最常见的潜在病因是神经病变、创伤、畸形、足底压力过高和外周动脉疾病。保护性感觉丧失是糖尿病患者足部溃疡的主要因素。关节畸形、关节活动受限以及足部护理/鞋具不佳所导致的机械应力，在神经性溃疡和缺血性溃疡的病因路径中都很重要。研究表明，足部感染复发在印度糖尿病患者中很常见（52%）。与西方国家患者（48%）相比，印度人外周血管疾病的患病率较低（13%）。吸烟会通过减少腿部血液循环和降低足部感觉来增加患病风险。对糖尿病足部溃疡进行及时、积极的治疗通常可以防止问题恶化，并消除截肢的可能性。治疗的目的应该是早期干预，以便使病变迅速愈合，并防止愈合后复发。专注于预防、教育、定期足部检查、积极干预以及优化使用治疗性鞋具的多学科管理方案，已显著降低了下肢截肢的发生率。
